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General NPI Number Information
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NPI Number | 1780635706
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Entity Type | Individual
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Provider Name | MARY SNYDER
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Gender | Female
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 3615 5TH ST SUITE 101
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City | RAPID CITY
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State | SD
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Zip | 57701-6014
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Country | US
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Telephone | 605-343-7208
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Fax | 605-343-7132
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Provider Business Mailing Address
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Address Line | 3615 5TH ST STE 101
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City | RAPID CITY
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State | SD
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Zip | 57701-7360
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Country | US
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Telephone | 605-343-7208
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Fax | 605-343-7132
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 21329
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 21329
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 5984
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License Number State | SD
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